PAR-Q (Physical Activity Readiness Questionnaire) Name * First Name Last Name Prounouns Email * Phone Date of Birth MM DD YYYY Emergency Contact (Name, phone number and relationship) * Do you have a heart condition? Yes No Do you feel pain in your chest when you perform physical activity? Yes No In the past month, have you had chest pain when you were not performing any physical activity? Yes No Do you lose your balance because of dizziness, or do you ever lose consciousness? Yes No Do you have a bone or joint problem that could be worsened by a change in your physical activity? Yes No Is your doctor currently prescribing any medications for your blood pressure? Yes No Do you know of any other reason why you should not engage in physical activity? Yes No If you answered "yes" to any of the above, please provide details. * Thank you!
